Care and safety: one client’s journey

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Reza was admitted to CAMH’s Complex Mental Illness program after his family brought him to the Emergency Department. The young college student was experiencing symptoms of acute psychosis and paranoia.

Because of his fears, he was preoccupied that people would harm him. He had lashed out at a family member, and had barricaded himself in his room during an earlier admission to a hospital. He didn’t accept that he was ill, so his main goal was to escape treatment.

“Our team was really keen to address Reza’s treatment needs while maintaining safety for him, his family, and staff,” says Social Worker Monica Beron. She recently supported Reza (his name has been changed for this story) while he was being treated at CAMH’s Structured Observation and Treatment Unit (SOTU), which has 8 acute-care beds.

Family played a key role

The care team quickly realized that Reza’s family could play a key role. “Their empowerment and support became a focus of the treatment plan,” says Monica. His parents, siblings and several friends participated in regular meetings to address care and safety.

While physicians attempted to find the right medication to address Reza’s symptoms, the team also customized care to his culture and needs. His family brought in traditional food each day, while the team engaged Reza’s religious community to provide spiritual services he had requested. Staff found CAMH colleagues who could speak Reza’s original language and understand his culture and religion. He spoke English fluently, but was sometimes calmer when speaking in his mother tongue. “We also brought in interpreters to bridge the language gap for some family who could not speak English,” says Monica.

Reza was given access to a computer and to the activity yard to stay active mentally and physically during recovery.

Strategies to minimize risk

At the same time, the team looked carefully at ways to maintain safety and minimize risk. The team uses a variety of strategies, says Advanced Practice Nurse Remar Mangaoil. A daily huddle known as Inter-professional Rapid Rounds brings the clinical team together to review the client’s care plan and risk assessment. Rapid Rounds help the team make adjustments in client care based on input from all team members. “We also use a group handover of information during shift changes to ensure collective knowledge.”

Two weekly meetings focus on the big picture of care and safety, Remar says.

“At our Clinical Supervision meeting we talk about complex situations and challenges. For example, the team made some modifications on how we were practicing continuous observation with Reza to be less intrusive. We explained to him why staff had to stay with him at all times, engaged him with arts and crafts, and ensured silence during his prayers. The meeting is also a chance for frank discussions with staff. We will ask: ‘What’s frustrating or upsetting you? How can we move forward as a team?’”

The second weekly meeting focuses on Safe Practices. It’s a chance to look at physical space and security procedures for continuous improvement – to ensure a culture of safety for both staff and clients, says Remar. “Something as simple as upgrading an intercom can make a big difference in supportive care. It’s the difference between having to raise your voice or speak normally when you are communicating with a client through a locked door.”

The team also reconsidered security around the staff lunch room following a time in which Reza had found his way in, asking to leave the secure unit.

A new beginning

The combination of tailored treatment and effective medication allowed Reza to start to go out on day passes, initially accompanied by a staff member. As he got better, Reza’s manner and communication changed, recalls Remar. “He was able to tell us that he never wanted to hurt anyone and that he was sorry for the times he had been aggressive.”

Reza was discharged in March and now attends CAMH’s outpatient Partial Hospitalization Program daily. Today, “Reza is working towards resuming his college courses in engineering,” says Monica. “He’s more insightful about what he needs to do to maintain wellness.” Reza has been connected with volunteering opportunities and understand the role of his meds to keep his psychosis symptoms at bay.

Remar adds: “He is a smart, polite and articulate young man -- with so much potential.”